Table of ContentsView AllTable of ContentsSymptomsCausesTypesPrognosis
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Types
Prognosis
Dysautonomiarefers to a group of disorders involving nerves that control heart rate, breathing, and other involuntary functions. Dysautonomia can be difficult to diagnose, in part because symptoms are linked to a range of health issues. Some causes are common, such asneuropathiesthat occur with diabetes. Others are rare genetic disorders.
Symptoms occur when theautonomic nervous system(ANS) doesn’t send or receive nerve signals as it should. Some people report dysautonomia associated with long COVID, and research to better understand the relationship is ongoing.Others experience it with Parkinson’s disease, heart problems, lupus, or for no clear reason at all—sometimes making it hard to diagnose the condition and cause.
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Symptoms and the Autonomic Nervous System
There are many conditions that affect these systems of the ANS, either as a primary cause of dysautonomia or as a secondary cause due to a health condition.The varied causes and emerging diagnoses, such as long COVID orpostural orthostatic tachycardiasyndrome (POTS), remain difficult to diagnose.
POTS, for example, can take more than five years on average to diagnose.Symptoms related to heart rate need to persist for three to six months before even considering the POTS diagnosis.
Dysautonomia symptoms are specific to the ANS dysfunction. They can include:
Not all people will experience the same symptoms of dysautonomia. Complicating the diagnosis is the fact that symptoms likeorthostatic hypotensioncan be a serious and late-stage finding of cardiac disease, or a side effect of medication that resolves with drug changes.
In some cases, healthcare providers may suspect anxiety or stress as a cause of dizziness before dysautonomia is accurately diagnosed.
What the Autonomic Nervous System ControlsThe bodily functions that ANS regulates include:Bladder and bowel functionHeart rate and blood pressureBreathingSaliva glands and digestionPupils dilating and tear production in eyesSexual functionTemperature regulation, including sweating
What the Autonomic Nervous System Controls
The bodily functions that ANS regulates include:Bladder and bowel functionHeart rate and blood pressureBreathingSaliva glands and digestionPupils dilating and tear production in eyesSexual functionTemperature regulation, including sweating
The bodily functions that ANS regulates include:
Dysautonomia arises from the malfunction of any part of the ANS. There are many causes of dysautonomia that can be broadly classified as being primary or secondary.
Primary Dysautonomia
There are at least 15 different types of primary dysautonomia, the most common of which areneurocardiogenic syncope(NCS) and POTS.
An inherited form of dysautonomia, known as Riley-Day syndrome, was first described in 1949. In later years,genetic testingidentified this as an inherited form of familial dysautonomia.
Secondary Dysautonomia
Secondary dysautonomia is the malfunction of the ANS due to another disease. Also known as intrinsic dysautonomia, it occurs when a disease damages the nerves of the ANS.
The possible causes of secondary dysautonomia are many and include:
Toxic exposure to chemicals and vitamin deficiencies also can lead to dysautonomia symptoms.
Types of Primary Dysautonomia
Researchers have identified at least 15 distinct types of primary dysautonomia. Some are common and may affect millions of people worldwide. Others are rare and may only be seen in certain groups.
Neurocardiogenic Syncope (NCS)
Neurocardiogenic syncope(NCS) is the most common form of dysautonomia, also known asvasovagal syncope. NCS causes fainting spells that occur either occasionally or frequently.
Orthostatic hypotension, also known as postural hypotension, is a steep drop in blood pressure while standing or rising. It is a feature of neurocardiogenic syncope and other forms of dysautonomia that causes dizziness and fainting spells.
Postural Orthostatic Tachycardia Syndrome (POTS)
Postural orthostatic tachycardia syndrome (POTS) causes your heart to beat too fast when you stand up, leading to chest pain, shortness of breath, and fainting.
Some researchers have speculated that POTS may be the result of an underlyingautoimmune condition(in which the immune system attacks certain tissues, such as those of the nervous system).It affects females more often than males, and people with POTS may also have:
Familial Dysautonomia (FD)
Familial dysautonomia (FD)is an inherited form of dysautonomia that causes decreased pain sensitivity, the absence of tears, and problems regulating body temperature. Other symptoms include:
Symptoms commonly develop during childhood. In some cases, FD can lead to a dysautonomic crisis, which causes rapid fluctuations in blood pressure and heart rate, dramatic changes in personality, and the complete shutdown of digestion.
Multiple System Atrophy (MSA)
Multiple system atrophy (MSA) is a severe form of dysautonomia that tends to affect people over 40. Symptoms of MSA include:
MSA is a rare condition that is commonly mistaken for Parkinson’s disease. The cause of MSA is unknown but does not appear to be genetic. What scientists have found is that certain parts of the brain break down over time in people with MSA.
MSA progresses rapidly and is often fatal. Sudden death often occurs during sleep due to paralysis of the lungs.
Pure Autonomic Failure (PAF)
The buildup of synuclein is seen with other conditions such as Parkinson’s disease. But unlike Parkinson’s, only certain body functions are affected.Symptoms include:
PAF is thought to be rare and tends to affect females more than males. The disorder may progress and lead to multiple symptom atrophy (MSA) in some people.
Keep in mind that research continues into dysautonomia linked to emerging causes like COVID-19, and much remains to be known about what causes ANS symptoms.
Managing Symptoms
Examples include:
Testing for DysautonomiaDiagnostic testing depends on the type. Postural orthostatic tachycardia syndrome (POTS) can be diagnosed based on your heart rate while lying on atilt table. Neurocardiogenic syncope (NCS) is diagnosed based on the exclusion of other possible causes.Familial dysautonomia (FD) can be diagnosed with an injection ofhistamine, which causes a specific skin reaction.
Testing for Dysautonomia
Diagnostic testing depends on the type. Postural orthostatic tachycardia syndrome (POTS) can be diagnosed based on your heart rate while lying on atilt table. Neurocardiogenic syncope (NCS) is diagnosed based on the exclusion of other possible causes.Familial dysautonomia (FD) can be diagnosed with an injection ofhistamine, which causes a specific skin reaction.
Summary
Dysautonomia is the malfunctioning of the autonomic nervous system (ANS) that regulates involuntary bodily functions. Dysautonomia is a common condition but it can be difficult to diagnose because the patterns and symptoms are so diverse.
Because the ANS regulates so many different functions—from breathing and heart rate to temperature regulation and sexual function—the possible symptoms of dysautonomia are vast. As a result, it can take time for a healthcare provider to identify dysautonomia as the cause of the symptoms.
16 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Hovaguimian A.Dysautonomia: Diagnosis and Management.Neurol Clin. 2023 Feb;41(1):193-213. doi:10.1016/j.ncl.2022.08.002Goldstein DS.Post-COVID dysautonomias: what we know and (mainly) what we don’t know.Nat Rev Neurol. 2024 Feb;20(2):99-113. doi:10.1038/s41582-023-00917-9Mahajan A, Morrow CB, Seemiller J, Mills KA, Pontone GM.The Effect of Dysautonomia on Motor, Behavioral, and Cognitive Fluctuations in Parkinson’s Disease.Mov Disord. 2024 Oct 25. doi:10.1002/mds.30044Rocha EA, Mehta N, Távora-Mehta MZP, Roncari CF, Cidrão AAL, Elias Neto J.Dysautonomia: A Forgotten Condition - Part 1.Arq Bras Cardiol. 2021 Apr;116(4):814-835. English, Portuguese. doi:10.36660/abc.20200420Benarroch EE.Physiology and Pathophysiology of the Autonomic Nervous System.Continuum (Minneap Minn). 2020 Feb;26(1):12-24. doi:10.1212/CON.0000000000000817.Dysautonomia International.Diagnosis delays in POTS.Olshansky B, Cannom D, Fedorowski A, Stewart J, Gibbons C, Sutton R,et al.Postural Orthostatic Tachycardia Syndrome (POTS): A critical assessment.Prog Cardiovasc Dis. 2020 May-Jun;63(3):263-270. doi:10.1016/j.pcad.2020.03.010.Academy of Neurological Physical Therapy.Orthostatic Hypotension.Bankenahally R, Krovvidi H.Autonomic nervous system: anatomy, physiology, and relevance in anaesthesia and critical care medicine.BJA Education.2016;16(11):381-87. doi:10.1093/bjaed/mkw011Dietrich P, Dragatsis I.Familial dysautonomia: mechanisms and models.Genet Mol Biol.2016 Oct-Dec;39(4):497–514. doi:10.1590/1678-4685-GMB-2015-0335Goldberger JJ, Arora R, Buckley U, Shivkumar K.Autonomic nervous system dysfunction.J Am Coll Cardiol.2019 Mar 19;73(10):1189–206 doi:10.1016/j.jacc.2018.12.064The Dysautonomia Project.Identifying dysautonomia.Gampa A, Upadhyay GA.Treatment of neurocardiogenic syncope: from conservative to cutting-edge.J Innov Card Rhythm Manag.2018 Jul;9(7):3221–31. doi:10.19102/icrm.2018.090702Jellinger KA.Multiple system atrophy: an oligodendroglioneural synucleinopathy.J Alzheimers Dis.2018;62(3):1141–79, doi:10.3233/JAD-170397Coon EA, Singer W, Low PA.Pure autonomic failure.Mayo Clin Proc. 2019 Oct;94(10):2087–98. doi:10.1016/j.mayocp.2019.03.009Yu H, Yuan X, Liu L, Want T, Gong D.Treatment of multiple system atrophy - the past, present and future.Am J Clin Exp Immunol.2018;7(5):88–94.
16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Hovaguimian A.Dysautonomia: Diagnosis and Management.Neurol Clin. 2023 Feb;41(1):193-213. doi:10.1016/j.ncl.2022.08.002Goldstein DS.Post-COVID dysautonomias: what we know and (mainly) what we don’t know.Nat Rev Neurol. 2024 Feb;20(2):99-113. doi:10.1038/s41582-023-00917-9Mahajan A, Morrow CB, Seemiller J, Mills KA, Pontone GM.The Effect of Dysautonomia on Motor, Behavioral, and Cognitive Fluctuations in Parkinson’s Disease.Mov Disord. 2024 Oct 25. doi:10.1002/mds.30044Rocha EA, Mehta N, Távora-Mehta MZP, Roncari CF, Cidrão AAL, Elias Neto J.Dysautonomia: A Forgotten Condition - Part 1.Arq Bras Cardiol. 2021 Apr;116(4):814-835. English, Portuguese. doi:10.36660/abc.20200420Benarroch EE.Physiology and Pathophysiology of the Autonomic Nervous System.Continuum (Minneap Minn). 2020 Feb;26(1):12-24. doi:10.1212/CON.0000000000000817.Dysautonomia International.Diagnosis delays in POTS.Olshansky B, Cannom D, Fedorowski A, Stewart J, Gibbons C, Sutton R,et al.Postural Orthostatic Tachycardia Syndrome (POTS): A critical assessment.Prog Cardiovasc Dis. 2020 May-Jun;63(3):263-270. doi:10.1016/j.pcad.2020.03.010.Academy of Neurological Physical Therapy.Orthostatic Hypotension.Bankenahally R, Krovvidi H.Autonomic nervous system: anatomy, physiology, and relevance in anaesthesia and critical care medicine.BJA Education.2016;16(11):381-87. doi:10.1093/bjaed/mkw011Dietrich P, Dragatsis I.Familial dysautonomia: mechanisms and models.Genet Mol Biol.2016 Oct-Dec;39(4):497–514. doi:10.1590/1678-4685-GMB-2015-0335Goldberger JJ, Arora R, Buckley U, Shivkumar K.Autonomic nervous system dysfunction.J Am Coll Cardiol.2019 Mar 19;73(10):1189–206 doi:10.1016/j.jacc.2018.12.064The Dysautonomia Project.Identifying dysautonomia.Gampa A, Upadhyay GA.Treatment of neurocardiogenic syncope: from conservative to cutting-edge.J Innov Card Rhythm Manag.2018 Jul;9(7):3221–31. doi:10.19102/icrm.2018.090702Jellinger KA.Multiple system atrophy: an oligodendroglioneural synucleinopathy.J Alzheimers Dis.2018;62(3):1141–79, doi:10.3233/JAD-170397Coon EA, Singer W, Low PA.Pure autonomic failure.Mayo Clin Proc. 2019 Oct;94(10):2087–98. doi:10.1016/j.mayocp.2019.03.009Yu H, Yuan X, Liu L, Want T, Gong D.Treatment of multiple system atrophy - the past, present and future.Am J Clin Exp Immunol.2018;7(5):88–94.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Hovaguimian A.Dysautonomia: Diagnosis and Management.Neurol Clin. 2023 Feb;41(1):193-213. doi:10.1016/j.ncl.2022.08.002Goldstein DS.Post-COVID dysautonomias: what we know and (mainly) what we don’t know.Nat Rev Neurol. 2024 Feb;20(2):99-113. doi:10.1038/s41582-023-00917-9Mahajan A, Morrow CB, Seemiller J, Mills KA, Pontone GM.The Effect of Dysautonomia on Motor, Behavioral, and Cognitive Fluctuations in Parkinson’s Disease.Mov Disord. 2024 Oct 25. doi:10.1002/mds.30044Rocha EA, Mehta N, Távora-Mehta MZP, Roncari CF, Cidrão AAL, Elias Neto J.Dysautonomia: A Forgotten Condition - Part 1.Arq Bras Cardiol. 2021 Apr;116(4):814-835. English, Portuguese. doi:10.36660/abc.20200420Benarroch EE.Physiology and Pathophysiology of the Autonomic Nervous System.Continuum (Minneap Minn). 2020 Feb;26(1):12-24. doi:10.1212/CON.0000000000000817.Dysautonomia International.Diagnosis delays in POTS.Olshansky B, Cannom D, Fedorowski A, Stewart J, Gibbons C, Sutton R,et al.Postural Orthostatic Tachycardia Syndrome (POTS): A critical assessment.Prog Cardiovasc Dis. 2020 May-Jun;63(3):263-270. doi:10.1016/j.pcad.2020.03.010.Academy of Neurological Physical Therapy.Orthostatic Hypotension.Bankenahally R, Krovvidi H.Autonomic nervous system: anatomy, physiology, and relevance in anaesthesia and critical care medicine.BJA Education.2016;16(11):381-87. doi:10.1093/bjaed/mkw011Dietrich P, Dragatsis I.Familial dysautonomia: mechanisms and models.Genet Mol Biol.2016 Oct-Dec;39(4):497–514. doi:10.1590/1678-4685-GMB-2015-0335Goldberger JJ, Arora R, Buckley U, Shivkumar K.Autonomic nervous system dysfunction.J Am Coll Cardiol.2019 Mar 19;73(10):1189–206 doi:10.1016/j.jacc.2018.12.064The Dysautonomia Project.Identifying dysautonomia.Gampa A, Upadhyay GA.Treatment of neurocardiogenic syncope: from conservative to cutting-edge.J Innov Card Rhythm Manag.2018 Jul;9(7):3221–31. doi:10.19102/icrm.2018.090702Jellinger KA.Multiple system atrophy: an oligodendroglioneural synucleinopathy.J Alzheimers Dis.2018;62(3):1141–79, doi:10.3233/JAD-170397Coon EA, Singer W, Low PA.Pure autonomic failure.Mayo Clin Proc. 2019 Oct;94(10):2087–98. doi:10.1016/j.mayocp.2019.03.009Yu H, Yuan X, Liu L, Want T, Gong D.Treatment of multiple system atrophy - the past, present and future.Am J Clin Exp Immunol.2018;7(5):88–94.
Hovaguimian A.Dysautonomia: Diagnosis and Management.Neurol Clin. 2023 Feb;41(1):193-213. doi:10.1016/j.ncl.2022.08.002
Goldstein DS.Post-COVID dysautonomias: what we know and (mainly) what we don’t know.Nat Rev Neurol. 2024 Feb;20(2):99-113. doi:10.1038/s41582-023-00917-9
Mahajan A, Morrow CB, Seemiller J, Mills KA, Pontone GM.The Effect of Dysautonomia on Motor, Behavioral, and Cognitive Fluctuations in Parkinson’s Disease.Mov Disord. 2024 Oct 25. doi:10.1002/mds.30044
Rocha EA, Mehta N, Távora-Mehta MZP, Roncari CF, Cidrão AAL, Elias Neto J.Dysautonomia: A Forgotten Condition - Part 1.Arq Bras Cardiol. 2021 Apr;116(4):814-835. English, Portuguese. doi:10.36660/abc.20200420
Benarroch EE.Physiology and Pathophysiology of the Autonomic Nervous System.Continuum (Minneap Minn). 2020 Feb;26(1):12-24. doi:10.1212/CON.0000000000000817.
Dysautonomia International.Diagnosis delays in POTS.
Olshansky B, Cannom D, Fedorowski A, Stewart J, Gibbons C, Sutton R,et al.Postural Orthostatic Tachycardia Syndrome (POTS): A critical assessment.Prog Cardiovasc Dis. 2020 May-Jun;63(3):263-270. doi:10.1016/j.pcad.2020.03.010.
Academy of Neurological Physical Therapy.Orthostatic Hypotension.
Bankenahally R, Krovvidi H.Autonomic nervous system: anatomy, physiology, and relevance in anaesthesia and critical care medicine.BJA Education.2016;16(11):381-87. doi:10.1093/bjaed/mkw011
Dietrich P, Dragatsis I.Familial dysautonomia: mechanisms and models.Genet Mol Biol.2016 Oct-Dec;39(4):497–514. doi:10.1590/1678-4685-GMB-2015-0335
Goldberger JJ, Arora R, Buckley U, Shivkumar K.Autonomic nervous system dysfunction.J Am Coll Cardiol.2019 Mar 19;73(10):1189–206 doi:10.1016/j.jacc.2018.12.064
The Dysautonomia Project.Identifying dysautonomia.
Gampa A, Upadhyay GA.Treatment of neurocardiogenic syncope: from conservative to cutting-edge.J Innov Card Rhythm Manag.2018 Jul;9(7):3221–31. doi:10.19102/icrm.2018.090702
Jellinger KA.Multiple system atrophy: an oligodendroglioneural synucleinopathy.J Alzheimers Dis.2018;62(3):1141–79, doi:10.3233/JAD-170397
Coon EA, Singer W, Low PA.Pure autonomic failure.Mayo Clin Proc. 2019 Oct;94(10):2087–98. doi:10.1016/j.mayocp.2019.03.009
Yu H, Yuan X, Liu L, Want T, Gong D.Treatment of multiple system atrophy - the past, present and future.Am J Clin Exp Immunol.2018;7(5):88–94.
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